Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes

Arch Cardiovasc Dis. 2017 Jun-Jul;110(6-7):389-394. doi: 10.1016/j.acvd.2016.10.005. Epub 2017 Apr 19.

Abstract

Background: Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access.

Aims: We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery.

Methods: Eighteen patients (10 men, 8 women; mean age 84±5 years) at high surgical risk (mean EuroSCORE II 16±13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64±0.13cm2 (0.36±0.07cm2/m2).

Results: At a mean follow-up of 605±352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n=1) or pneumonia (n=1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8±3mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48±31h; mean in-hospital stay was 7±3 days.

Conclusion: TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.

Keywords: Aortic stenosis; Artère carotide commune; Artère fémorale; Artériopathie périphérique; Common carotid artery; Femoral artery; Implantation transvalvulaire d’une valve aortique; Peripheral artery disease; Sténose aortique; Transcatheter aortic valve implantation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Carotid Artery, Common* / diagnostic imaging
  • Disease-Free Survival
  • Feasibility Studies
  • Female
  • Femoral Artery / diagnostic imaging
  • Heart Valve Prosthesis
  • Hemodynamics
  • Hospital Mortality
  • Humans
  • Length of Stay
  • Male
  • Peripheral Arterial Disease / complications*
  • Peripheral Arterial Disease / diagnostic imaging
  • Prospective Studies
  • Prosthesis Design
  • Recovery of Function
  • Time Factors
  • Transcatheter Aortic Valve Replacement / adverse effects
  • Transcatheter Aortic Valve Replacement / instrumentation
  • Transcatheter Aortic Valve Replacement / methods*
  • Transcatheter Aortic Valve Replacement / mortality
  • Treatment Outcome